Abdominal pain: Difference between revisions
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''For pediatric patients see [[Abdominal pain (peds)]]. See also [[abdominal pain (geriatrics)]] and [[Abdominal pain in pregnancy]].'' | |||
==Background== | ==Background== | ||
* | *Patients with immunosuppression often have delayed or atypical presentations | ||
*[[Fever]] is not a reliable marker for surgical disease | |||
*Abdominal pain may be particularly misleading in elderly or diabetics | |||
*Consider pain in any abdominal or pelvic region in a female of child-bearing age, including pre-teens, is an [[ectopic pregnancy]] until proven otherwise | |||
*Fever is not a reliable marker for surgical disease | |||
{{Abdominal pain location}} | |||
== | ==Clinical Features== | ||
*Abdominal pain (see workup by location) | |||
*May be associated with [[nausea]], [[vomiting]] or [[diarrhea]] | |||
*[[Fever]] may be present in pain from infectious etiology | |||
== | ==Differential Diagnosis== | ||
{{Abdominal Pain DDX Diffuse}} | |||
{{Abdominal Pain DDX Epigastric}} | |||
{{DDX RUQ}} | |||
{{DDX LUQ}} | |||
{{Abd DDX RLQ}} | |||
{{LLQ DDX}} | |||
{{Pelvic pain DDX}} | |||
{{Extra-abdominal sources of abdominal pain DDX}} | |||
== | ==Evaluation== | ||
*Workup is by location: | |||
**[[RUQ pain]] | |||
**[[RLQ pain]] | |||
**[[Epigastric pain]] | |||
**[[LUQ pain]] | |||
**[[LLQ pain]] | |||
**[[Diffuse abdominal pain]] | |||
**[[Flank pain]] | |||
=== | ==Management== | ||
*Treat underlying cause | |||
*Multiple studies show [[pain medicine]] should not be withheld for fear of masking symptoms | |||
== | ==Disposition== | ||
*Depends on etiology | |||
*The two most notoriously missed conditions are [[appendicitis]] and [[small bowel obstruction]].<ref>Macaluso CR and McNamara RM. Evaluation and management of acute abdominal pain in the emergency department. Int J Gen Med. 2012; 5: 789–797. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3468117/</ref>. When discharging patients with abdominal pain, clear instructions should be given for return if there are red flags. | |||
== | ==See Also== | ||
*[[Abdominal Pain (Geriatrics)]] | |||
*[[Abdominal Pain (Peds)]] | |||
*[[Abdominal Trauma]] | |||
*[[Abdominal pain in pregnancy]] | |||
*[[Pelvic Pain]] | |||
==References== | |||
<references/> | |||
[[Category:GI]] | [[Category:GI]] | ||
[[Category:Misc/General]] | |||
[[Category:Symptoms]] |
Latest revision as of 22:35, 31 January 2024
For pediatric patients see Abdominal pain (peds). See also abdominal pain (geriatrics) and Abdominal pain in pregnancy.
Background
- Patients with immunosuppression often have delayed or atypical presentations
- Fever is not a reliable marker for surgical disease
- Abdominal pain may be particularly misleading in elderly or diabetics
- Consider pain in any abdominal or pelvic region in a female of child-bearing age, including pre-teens, is an ectopic pregnancy until proven otherwise
Classification by Abdominal pain location
RUQ pain | Epigastric pain | LUQ pain |
Flank pain | Diffuse abdominal pain | Flank pain |
RLQ pain | Pelvic pain | LLQ pain |
Clinical Features
- Abdominal pain (see workup by location)
- May be associated with nausea, vomiting or diarrhea
- Fever may be present in pain from infectious etiology
Differential Diagnosis
Diffuse Abdominal pain
- Abdominal aortic aneurysm
- Acute gastroenteritis
- Aortoenteric fisulta
- Appendicitis (early)
- Bowel obstruction
- Bowel perforation
- Diabetic ketoacidosis
- Gastroparesis
- Hernia
- Hypercalcemia
- Inflammatory bowel disease
- Mesenteric ischemia
- Pancreatitis
- Peritonitis
- Sickle cell crisis
- Spontaneous bacterial peritonitis
- Volvulus
Epigastric Pain
- Gastroesophageal reflux disease (GERD)
- Peptic ulcer disease with or without perforation
- Gastritis
- Pancreatitis
- Gallbladder disease
- Myocardial Ischemia
- Splenic Infarctionenlargement/rupture/aneurysm
- Pericarditis/Myocarditis
- Aortic dissection
- Hepatitis
- Pyelonephritis
- Pneumonia
- Pyogenic liver abscess
- Fitz-Hugh-Curtis Syndrome
- Hepatomegaly due to CHF
- Bowel obstruction
- SMA syndrome
- Pulmonary embolism
- Bezoar
- Ingested foreign body
RUQ Pain
- Gallbladder disease
- Pancreatitis
- Acute hepatitis
- Pancreatitis
- GERD
- Appendicitis (retrocecal)
- Pyogenic liver abscess
- Bowel obstruction
- Cirrhosis
- Budd-Chiari syndrome
- GU
- Other
- Hepatomegaly due to CHF
- Peptic ulcer disease with or without perforation
- Pneumonia
- Herpes zoster
- Myocardial ischemia
- Pulmonary embolism
- Abdominal aortic aneurysm
Left upper quadrant abdominal pain
- GERD
- Peptic ulcer disease with or without perforation
- Pancreatitis
- Splenic infarction/Splenic artery aneurysm rupture
- Pyelonephritis
- Bowel obstruction
- Myocardial Ischemia
- Pneumonia
- Pulmonary embolism
- Herpes zoster
- Pericarditis/Myocarditis
- Aortic Dissection
RLQ Pain
- GI
- Appendicitis
- Perforated appendicitis
- Peritonitis
- Crohn's disease (terminal ileitis)
- Diverticulitis (cecal, Asian patients)
- Inguinal hernia
- Mesenteric ischemia
- Ischemic colitis
- Meckel's diverticulum
- Neutropenic enterocolitis (typhlitis)
- Appendicitis
- GU
- Other
LLQ Pain
- Diverticulitis
- Kidney stone
- UTI
- Pyelonephritis
- Ectopic pregnancy
- Infectious colitis
- Inflammatory bowel disease (Crohn's Disease, Ulcerative Colitis)
- Inguinal hernia
- Mesenteric ischemia
- Epiploic appendagitis
- Mittelschmerz
- Ovarian cyst
- Ovarian torsion
- PID
- Psoas abscess
- Testicular torsion
- Appendicitis
- Abdominal aortic aneurysm
- Herpes zoster
- Endometriosis
- Colon cancer
- Irritable bowel syndrome
- Small bowel obstruction
Acute Pelvic Pain
Gynecologic/Obstetric
- Normal variants
- Nabothian cysts: Epithelial cells within mucous glans that appear as yellow inclusions on the cervix
- Cervial Ectropion: Edothelial cells on the exterior of the cervix
- Parous cervix: The is no longer round but may have multiple shapes after birth
- Pregnancy-related
- Ectopic Pregnancy
- Spontaneous abortion, threatened or incomplete
- Septic abortion
- Acute Infections
- Vulvovaginitis
- Adnexal Disorders
- Hemorrhage/rupture of ovarian cyst
- Ovarian torsion
- Twisted paraovarian cyst
- Other
- Myoma (degenerating)
- Genitourinary trauma
- Ovarian hyperstimulation syndrome
- Sexual assault
- Recurrent
- Mittelschmerz
- Primary/Secondary Dysmenorrhea
- Pelvic Congestion Syndrome
- Endometriosis
Genitourinary
Gastrointestinal
- Gastroenteritis
- Appendicitis
- Bowel obstruction
- Perirectal abscess
- Diverticulitis
- Inflammatory bowel disease
- Irritable bowel syndrome
- Mesenteric adenitis
Musculoskeletal
- Abdominal wall hematoma
- Psoas hematoma, psoas abscess
- Hernia
Vascular
- Pelvic thrombophlebitis
- Abdominal aortic aneurysm
- Ischemic bowel (Mesenteric Ischemia)
Extra-abdominal Sources of Abdominal pain
- MI
- Aortic Dissection
- PNA
- PE
- Testicular Torsion
- Herpes Zoster
- Muscle spasm
- Spinal pathology
- Strep Pharyngitis (peds)
- Mononucleosis
- DKA
- ETOH Ketoacidosis
- Uremia
- Sickle Cell Crisis
- SLE
- Vasculitis
- Glaucoma
- Hyperthyroidism
- Methanol Poisoning
- Heavy Metal toxicity
- Addison's disease
- Porphyria
- Paroxysmal nocturnal hemoglobinuria
- Black widow spider bite
Evaluation
- Workup is by location:
Management
- Treat underlying cause
- Multiple studies show pain medicine should not be withheld for fear of masking symptoms
Disposition
- Depends on etiology
- The two most notoriously missed conditions are appendicitis and small bowel obstruction.[2]. When discharging patients with abdominal pain, clear instructions should be given for return if there are red flags.
See Also
- Abdominal Pain (Geriatrics)
- Abdominal Pain (Peds)
- Abdominal Trauma
- Abdominal pain in pregnancy
- Pelvic Pain
References
- ↑ Norris DL, Young JD. UTI. EM Clin N Am. 2008; 26:413-30.
- ↑ Macaluso CR and McNamara RM. Evaluation and management of acute abdominal pain in the emergency department. Int J Gen Med. 2012; 5: 789–797. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3468117/